ABSTRACT
Three patients who developed acute onset of cerebral blindness within 5-47 days of BMT using tacrolimus (FK506) as primary GVHD prophylaxis are described. This syndrome has been described with the use of cyclosporin A (CsA) and FK506 in solid organ transplant recipients. CsA-induced cerebral blindness has also been noted in BMT recipients but to date there have been no reports of this complication in BMT patients receiving FK506. We have noted a striking similarity in the clinical and radiographic presentations between these patients and those with CsA-associated cerebral blindness. Reversibility within 1-2 weeks of onset and the potential for substitution of CsA for FK506 in these patients is described.
Subject(s)
Blindness/etiology , Bone Marrow Transplantation , Brain/drug effects , Immunosuppressive Agents/adverse effects , Tacrolimus/adverse effects , Adult , Cyclosporine/adverse effects , Female , Humans , Magnetic Resonance Imaging , MaleABSTRACT
Superior oblique myokymia (SOM) is an uncommon ocular motility disorder characterized by intermittent uniocular vertical or torsional oscillations with periodic remissions and exacerbations. Although generally idiopathic in origin, isolated case reports have documented its association with intracranial pathology. We present a case of superior oblique myokymia associated with a dural arteriovenous fistula.
Subject(s)
Arteriovenous Fistula/physiopathology , Dura Mater/physiopathology , Fasciculation/physiopathology , Adult , Arteriovenous Fistula/diagnostic imaging , Cerebral Angiography , Dura Mater/diagnostic imaging , Fasciculation/diagnostic imaging , Female , HumansABSTRACT
PURPOSE: To determine whether pupillary responses to dilute tropicamide could be used as a diagnostic test for Alzheimer disease (AD). The authors also investigated whether concurrent use of an oral acetylcholinesterase inhibitor (tacrine) alters the pupillary response to dilute tropicamide in patients with AD, and whether pupillary responses to dilute tropicamide differ in young versus older control subjects. METHODS: Pupillary diameter and area of both eyes were measured in light and darkness, at 10-minute intervals for 40 minutes after random instillation of 0.01% tropicamide to one eye. Four groups of subjects were studied: 9 patients with AD, 10 who were treated with tacrine, 11 older control subjects, and 10 young control subjects. RESULTS: Mean change in anisocoria was not significantly different among groups at any of the measurement time points. Mean percent change in diameter of the treated eyes showed a trend toward faster maximum dilatation in the AD groups, but change in pupillary measurements did not identify individuals with AD. CONCLUSION: Pupillary response to dilute tropicamide did not effectively distinguish individual patients with AD from young or older control subjects.